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Lumbar spine injuries resulting from heavy or repetitive lifting remain a prevalent concern in workplaces. Back-support devices have been developed to mitigate these injuries by aiding workers during lifting tasks. However, existing devices often fall short in providing multidimensional force assistance for asymmetric lifting, an essential feature for practical workplace use. In addition, validation of device safety across the entire human spine has been lacking. This paper introduces the Bilateral Back Extensor Exosuit (BBEX), a robotic back-support device designed to address both functionality and safety concerns. The design of the BBEX draws inspiration from the anatomical characteristics of the human spine and back extensor muscles. Using a multi-degree-of-freedom architecture and serially connected linear actuators, the device's components are strategically arranged to closely mimic the biomechanics of the human spine and back extensor muscles. To establish the efficacy and safety of the BBEX, a series of experiments with human participants was conducted. Eleven healthy male participants engaged in symmetric and asymmetric lifting tasks while wearing the BBEX. The results confirm the ability of the BBEX to provide effective multidimensional force assistance. Moreover, comprehensive safety validation was achieved through analyses of muscle fatigue in the upper and the lower erector spinae muscles, as well as mechanical loading on spinal joints during both lifting scenarios. By seamlessly integrating functionality inspired by human biomechanics with a focus on safety, this study offers a promising solution to address the persistent challenge of preventing lumbar spine injuries in demanding work environments.

Background: Motorcycle crashes pose a persistent public health problem with disproportionate rates of severe injuries and mortality. This study aims to analyze injury patterns and outcomes with regard to helmet use. We hypothesized that helmet use is associated with fewer head injuries and does not increase the risk of cervical spine injuries., Methods: The National Trauma Data Bank was queried for all motorcycle driver crashes between 2007-2017. Univariable analysis was used to compare demographics, clinical data, injury patterns using abbreviated injury scale, and outcomes between helmeted motorcycle drivers and non-helmeted motorcycle drivers who were injured in traffic crashes. Independent factors associated with mortality were determined by regression analysis after adjustment for potential confounders., Results: A total of 315,258 patients were included for analysis, 66 % of these patients were helmeted. The sample was 92.5 % male and the median age was 41 years. Non-helmeted motorcycle drivers were more likely to sustain severe head trauma (head abbreviated injury scale ≥ 3: 28.5 % vs. 13.3 %, p < 0.001), had higher intensive care unit-admission (38 % vs. 30.2 %, p<0.001), mechanical ventilation (20.1 % vs. 13 %, p<0.001) and overall mortality rates (6.2 % vs. 3.9 %, p<0.001). Cervical spine injuries occurred in 10.6 % of non-helmeted motorcycle drivers and in 9.5 % of helmeted motorcycle drivers (p<0.001). Helmet use was identified as an independent factor associated with lower mortality [OR 0.849 (0.809-0.891), p<0.001]., Conclusion: Helmet use is protective for severe head injuries and associated with decreased mortality. Helmet use was not associated with increased rates of cervical spine injuries. On the contrary, fewer injuries were observed in helmeted motorcycle drivers. Public health initiatives should be aimed at enforcement of universal helmet laws within the United States and across the world., Competing Interests: Declaration of Competing Interest The authors listed have no conflicts of interest and these data have not been published elsewhere., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: The purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury., Methods: Data acquisition was performed using the Trauma Register DGU® (TR-DGU) in the time period from 2010 to 2019 of seriously injured children (AIS 2 +) aged 0-5 years as motor vehicle passengers (MVP). Primarily treated and transferred patients where included., Results: The study group included 727 of 2030 (35.8%) children, who were severely injured (AIS 2 +) in road traffic accidents, among them 268 (13.2%) as MVPs in the age groups: 0-1 years (42.5%), 2-3 years (26.1%) and 4-5 years (31.3%). The pattern of severe injury was head/brain (56.0%), thoracic (42.2%), abdominal (13.1%), fractures (extremities and pelvis, 52.6%) and spine/severe whiplash (19.8%). The 0-1-year-old MVPs showed the significantly highest proportion of brain injuries with Glasgow Coma Score (GCS) < 8 and severe injury to the spine. The 2-3-year-olds showed the significantly highest proportion of fractures especially the lower extremity and highest proportion of cervical spine injuries of all spine injuries, while the 4-5-year-olds, the significantly highest proportion of abdominal injury and second highest proportion of cervical spine injury of all spine injuries. MVPs of the 0-1-year-old and 2-3-year-old groups showed a higher median Injury Severity Score (ISS) of 21.5 and 22.1 points than the older children (17.0 points). They also suffered an AIS-6-injury significantly more often (9 of 21) of spine (p = 0.001). Especially the cervical spine was significantly more often involved. Passengers at the age of 0-1 years were treated with cardiopulmonary resuscitation (CPR) three times as often as older children in the prehospital setting and twice as often at admission in the Trauma Resuscitation Unit (TRU). Their survival rate was 7 out of 8 (0-1 years), 1 out of 6 (2-3 years) and 1 out of 4 (4-5 years)., Conclusion: Although the younger MVPs are restraint in a re-boarding position, severe injury to the spine and head occurred more often, while older children as front-faced positioned MVPs suffered from significantly higher rates of abdominal and more often severe facial injury. Our data show, that it is more important to properly restrain children in their adequate car seats (i-size-Norm) and additionally consider the age-related physiological and anatomical specific risks of injury as well as co-factors in road traffic accidents, than only prolonging the re-boarding position over the age of 15 months as a single method., (© 2022. The Author(s).)

Spinal injury and back pain are a common problem facing patients seeking medical care including athletes, which can lead to significant disability, medical costs, and impaired performance for these patients. Rehabilitation including core muscle stabilization, Kinesio taping, and flexibility have been shown to help with treatment and prevention. Critical factors such as equipment, technique, and rule changes can also be an important part of spine injury prevention., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Abstract: Cervical spinal injuries are a rare, but potentially devastating occurrence in sports. Although many of these injuries occur in unsupervised sports, they are also seen in organized sports - most commonly in football, wrestling, and ice hockey. Additionally, although each sport is associated with its own unique injury patterns, axial loading remains a common theme seen in cervical injuries associated with significant neurologic impairment. Regardless of the mechanism, a cautious and conservative approach should be taken with regards to evaluation, management, and return to play., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Objective: Motorcycle helmets are the most common and effective protective device to reduce head injuries and mortality in crashes among powered two-wheeler riders. Even if they are globally recognized as effective, there are still concerns regarding their correct use, which is necessary to achieve maximum head protection. The goal of this systematic review is to assess which characteristics of helmet design and use showed a positive influence on rider safety, in order to provide insights to improve end-user helmet usage., Methods: A literature search was carried out combining two sets of keywords, one related with either motorcycle or rider and the other referring to either protective equipment or injuries. After the exclusion of duplicates, 977 papers were screened by reviewers, thus identifying 32 papers that were analyzed in group discussions., Results: Among the papers included in this study, no strong conflicting conclusions emerged in their results. The studies focusing on the use of different types of helmets highlighted that full-face helmets, compared with other standard helmets, have a positive influence on head injuries and facial injuries. Correct fastening was clearly beneficial for head and facial injuries, induced injuries, and helmet ejection., Conclusions: This systematic review provides important insights to improve the usage of helmets by end-users. Correct fastening is a crucial factor to avoid helmet roll-off during a crash. Most studies agreed that full-face helmets provide higher protection in comparison with other standard helmets, especially for facial injuries, and no negative influence with respect to neck and spinal injuries.

Astronauts are at increased risk of spine injury. With a view to developing training approaches for the muscles of the spine in microgravity, this study examined the effects of axial loading and postural cues on the contraction of transversus abdominis and lumbar multifidus in supine lying using a novel exercise device (GravityFit). Thirty (18 males and 12 females) endurance-trained runners without a history of spinal pain aged 33-55 years were recruited. Magnetic resonance imaging (MRI) was performed under one rest and five exercise conditions, which involved variations in axial loading and postural cues. Whole volume of the abdominal and lumbar paraspinal muscles was imaged and transversus abdominis thickness and length and multifidus anteroposterior and mediolateral thickness measured. Transversus abdominis contraction was greatest in the 'stretch tall plus arm extension' (length, - 15%, P < 0.001; thickness, + 19%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (length, - 16%, P < 0.001; thickness, + 18%, P < 0.001) conditions. The contraction of multifidus was the greatest in the 'arm extension and thoracic cue' (anteroposterior, + 3.0%, P = 0.001; mediolateral, - 4.2%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (anteroposterior, + 6.0%, P < 0.001; mediolateral, - 2.1%, P = 0.022) conditions. This study provides proof-of-principle for an exercise approach that may be used to facilitate the automatically contraction of the transversus abdominis and multifidus muscles. Axial loading of the body, with or without arm loading, most consistently led to contraction of the transversus abdominis and lumbar multifidus muscles, and regional differences existed in the contraction within the muscles.

Introduction: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs., Methods: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review., Results: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved., Conclusions: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

Context and Objective: Among the different products and protective gear used by riders of two-wheeled motorized vehicles, back protectors that are designed to prevent damage to the spinal column are widely used today compared other protections. However, few studies measure their effectiveness. Can their effectiveness be measured? How do they help decrease or change the nature of thoracolumbar traumas that occur? To address these questions and remedy the lack of objective data regarding these products, an epidemiological, clinical, and biomechanical analysis of motorcycle riders who were admitted to a French trauma center after an accident was performed. So, this study investigates the effectiveness of back protectors, including their ability to prevent specific mechanisms of thoracic and lumbar spinal injuries related to TWMV accidents., Method: A questionnaire was administered to victims of accidents involving two-wheeled motorized vehicles who were admitted to the trauma room at the Marseille trauma center over the course of 2016. Collect data are related to the victim, the accident scenario, and a detailed description of the observed injuries using AIS (Abbreviated Injury Scale) coding and Magerl classification. Univariate analyses and Fisher tests were performed for victims who were or were not wearing back protectors., Results: This study collected data from 124 victims. Almost half of the victims were wearing a back protector at the time of the accident (53 victims, thus 43% of riders). Collectively, twenty-nine victims who were wearing back protectors had 57 thoracolumbar injuries, and twenty eight victims who were not wearing back protectors had 75 thoracolumbar lesions. The results from this study show that there is no significant difference in the nature and mechanism of thoracolumbar injuries as a function of back protection. The majority of the thoracolumbar injuries were not severe. They were primarily bone injuries, essentially compression fractures, regardless of whether a back protector was worn., Conclusion: This study shows that the use of back protection does not decrease the number, type, or mechanism of thoracolumbar injuries associated with accidents involving two-wheeled motorized vehicles. However, it suggests that lumbar vertebral injuries are deflected towards the thoracic vertebrae when back protectors are worn. Finally, it suggests that the design of back protectors should be reconsidered to better protect riders from what are referred to as compression fractures (craniocaudal force), which remain the primary form of fracture regardless of the rider's characteristics, based on the data analyzed., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction: To evaluate the long-term consolidation of vertebral metastases (VM) after preventive vertebroplasty (PV) and to report risk factors of pathological fracture despite PV., Materials and Methods: Files of 100 consecutives cancer patients referred for PV of VM were retrospectively analyzed. We enumerated 215 VM at the time of the PV procedure (T0): 138 VM were considered at risk of pathological fracture and had PV (treated-VM), and 77 VM were not cemented. We compared the VM characteristics using the spine instability neoplastic score (SINS) at T0 and the rate of pathologic fracture between treated-VM and untreated-VM using Kaplan-Meier method. We analyzed risk factors of pathological fracture despite PV using treated-VM characteristics and quality of cement injection criteria., Results: Despite a lower SINS value at T0 (p < 0.001), the rate of pathological fracture was significantly higher among untreated-VM compared to the treated-VM, (log-rank, p < 0.001). Major risk factors of fracture among treated-VM were: SINS value ≥ 8 (p < 0.012), mechanical pain (p = 0.001), osteolytic lesion (p = 0.033), metastatic vertebral body involvement > 50% with no collapse (p < 0.001) and unilateral posterior involvement by the vertebral metastasis (p = 0.024), Saliou score < 9 (p = 0.008), vertebral metastasis filling with cement < 50% (p = 0.007) and the absence of cement's contact with vertebral endplates (p = 0.014)., Conclusion: PV is long-term effective for consolidation of VM and must be discussed at the early diagnosed. Quality of cement injection matters, suggesting that techniques that improve the quantity and the quality of cement diffusion into the VM must be developed.

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards., (Copyright © 2019 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

A short cut review was carried out to establish whether patients presenting to the emergency department after a near drowning should have cervical spine immobilisation. A search of the literature found only three studies directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that cervical spine injuries are rare in drowning and near drowning unless there is a history of diving or a fall or signs of trauma. Cervical spine immobilisation should be reserved for cases where there is a reasonable suspicion of a spinal injury., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The objective was to investigate the effects of functional (FT) and traditional (TT) training on trunk muscles maximal isometric strength, rate of force development and endurance with trained elderly women. Forty-five elderly women were directed into three groups: FT (n =1 6), TT (n = 14) and Control (n = 15). The FT (multi-planar, and multi-articular movements) and TT (primarily machine-based resistance exercises) performed mobility, muscle strength and power exercises. Both training groups also performed intermittent cardiometabolic activities. The maximum strength and endurance of the trunk muscles were verified, both at baseline and after 12 weeks of training (3xweek for 50 min each). Data were analyzed using a 2-way ANCOVA with contrast of adjusted mean values. FT significantly increased all variables: maximum trunk flexor strength (p = 0.002, 22%); rate of flexor force development (p = 0.001, 84%); trunk extensors maximal strength (p = 0.003, 17%); trunk extensor rate of force development (p = 0.05, 16%); trunk flexors (p = 0.001, 19%) and extensors (p = 0.017, 13%) endurance compared to baseline. TT showed an increase only in RFD of trunk extensors (p = 0.003, 53%), and flexors (p = 0.033, 42%), and trunk flexors endurance (p = 0.008, 11%). However, there was no statistically significant difference between groups. FT promoted improvement in all variables; strength, endurance and rate of force development of the trunk flexors and extensors of the elderly. On the other hand, TT improved only the rate of force development of trunk flexors and extensors and endurance of the trunk flexors. FT is recommended for elderly women as it improves a broader array of physiological parameters., (© Journal of Sports Science and Medicine.)

Background: There is uncertainty regarding the efficacy of ski helmets in preventing traumatic injury. We investigated the relationship between helmet use, injury types, and injury severity among skiers and snowboarders., Methods: The trauma registry at a Northeast American College of Surgeons Level I trauma center was queried by International Classification of Diseases Codes-9th or 10th Revision for skiing and snowboarding injury between 2010 and 2018. The primary exposure was helmet use and primary outcome was severe injury (Injury Severity Score >15). We performed univariate and multivariable logistic regression to assess for injury types and severity associated with helmet use., Results: Seven hundred twenty-one patients (65% helmeted, 35% unhelmeted) met inclusion criteria. Helmet use doubled during the study period (43% to 81%, p < 0.001), but the rate of any head injury did not significantly change (49% to 43%, p = 0.499). On multivariable regression, helmeted patients were significantly more likely to suffer severe injury (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.30-3.11), intracranial hemorrhage (OR, 1.81; 95% CI, 1.10-2.96), chest injury (OR, 1.66; 95% CI, 1.05-2.61), and/or lumbosacral spine injury (OR, 1.84; 95% CI, 1.04-3.25) than unhelmeted patients. Helmeted patients were half as likely to suffer cervical spine injury (OR, 0.51; 95% CI, 0.30-0.89) and a third as likely to sustain skull fracture and/or scalp laceration (OR, 0.30; 95% CI, 0.14-0.64). More patients who hit a stationary object were helmeted compared with those who fell from standing height onto snow (70% vs. 56% respectively, p < 0.001). After adjustment, hitting a stationary object was the injury mechanism most significantly associated with severe injury (OR, 2.80; 95% CI, 1.79-4.38)., Conclusion: Helmeted skiers and snowboarders evaluated at a Level I trauma center were more likely to suffer severe injury, including intracranial hemorrhage, as compared with unhelmeted participants. However, they were less likely to sustain skull fractures or cervical spine injuries. Helmeted patients were also more likely to hit a stationary object. Our findings reinforce the importance of safe skiing practices and trauma evaluation after high-impact injury, regardless of helmet use., Level of Evidence: Prognostic and epidemiological, level IV.

Background: Recent studies demonstrate an association between spinal immobilization and neck pain, increased use of radiographs, and increased admission rates for pediatric trauma patients. There is an increasing trend toward spinal protection protocols that limit the use of backboards in trauma patients. However, many of these protocols do not address the youngest patients. Objectives: The objective was to analyze whether implementation of a selective prehospital pediatric spinal protection protocol was associated with a reduction in spinal imaging, hospital admission rates, and Emergency Department (ED) length of stay (LOS). Methods: We conducted a single center retrospective chart review to assess the effect of implementing a new selective pediatric spinal immobilization protocol in an EMS system. Patients transported to the same center from a neighboring EMS jurisdiction without a protocol change were analyzed for comparison. We extracted data for all pediatric patients with trauma-related discharge diagnoses transported by EMS to a pediatric trauma center for one year before and after the implementation of the protocol. Results: There were 878 eligible trauma patients transported under the new protocol, compared to 782 transported prior to implementation. We did not find a significant difference in the percentage of trauma patients who received spinal imaging pre- and post-protocol change (20% vs. 18%, OR 0.84 [95% CI 0.66, 1.07]), but did observe a significant reduction in the proportion of trauma patients who were admitted to the hospital (25% vs. 18%, OR 0.66 [95% CI 0.52, 0.83]). This reduced admission rate was not observed in the neighboring jurisdiction. Conclusions: Implementation of a selective spinal immobilization protocol was associated with reduced admission rates, but did not significantly reduce rates of plain radiographs.

Wool harvesting remains an important industry in Australia, but its workers suffer from extreme rates of injury, in particular, the lower back injuries. Reducing injuries in sheep shearing could be as simple as extending shearer rest periods between sheep, but the effect of this has not previously been studied. The lumbar flexion-relaxation phenomenon is present in sheep shearing and the onset angle of this phenomenon can provide insight into lower back injury risk. The increase in the onset angle of lumbar flexion-relaxation over several work-rest periods for a simulated sheep shearing task is studied. The rate of increase in the onset angle of lumbar flexion-relaxation was higher when shorter breaks were taken for all participants at least unilaterally, indicating that longer rest breaks could reduce back injury risk. Due to the constraints of the sheep shearing occupation, this type of intervention is better suited to learner and novice shearers. Assistive robotic devices would be more suited to reduce injuries in expert shearers, and some insight is provided for the application of these within sheep shearing. Further study of this phenomenon in sheep shearing could provide additional insight to developing an assistive device that could reduce injury.

Background: Head-first impacts with an aligned cervical spine cause some of the most severe types of injuries due to the risk of fractures and associated spinal cord injury. Sports, such as football, mountain biking and horseback riding, contribute to the incidence of spinal cord injury but there is potential to reduce the risk of these injuries through a helmet-mounted device., Methods: A novel device, the Pro-Neck-Tor mechanism, was incorporated into a commercial football helmet and tested in head-first impact experiments. The Pro-Neck-Tor connects an inner and outer helmet shell, which upon head-first impact of a certain load, induces motion of the head away from the path of the following torso. Impacts were performed onto three impact surface angles with a flexion-inducing Pro-Neck-Tor mechanism., Findings: Based on averaged data, the Pro-Neck-Tor provided a significant and consistent reduction in peak compressive neck forces compared to the unmodified football helmet in the conditions tested. In some impact conditions, the Pro-Neck-Tor increased the peak sagittal plane neck bending moments and impulse over that observed for the unmodified helmet., Interpretation: The Pro-Neck-Tor with flexion escape is capable of lowering axial neck forces in head-first impacts compared to a conventional helmet by guiding the cervical column away from an aligned posture and into an eccentric loading scenario which published studies suggests frequently leads to no injury or to a less severe injury. Continued development and testing of the device are needed to optimize the altered neck loading and to drive the design toward a commercial configuration., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: A missed cervical spinal injury could have devastating consequences. Patients with a suspected cervical spinal injury are kept in rigid collars for cervical immobilisation. Prolonged collar use has important clinical implications. A well-defined guideline related to the removal of cervical collars from adult obtunded blunt trauma patients has not been developed., Aim: We sought to determine if Magnetic Resonance Imaging offered a definitive benefit over Computer Tomography with respect to patient management., Method: We searched Ovid Online, EBSCO, NICE Evidence Journals, Medline, PubMED, BNI, CINAHL and Google Scholar as well as the grey literature. Data extraction and synthesis were performed on studies that compared the radiologic findings and clinical outcomes of Computer Tomography scan and Magnetic Resonance Imaging in this patient group., Results: There is evidence that supports the safe discontinuation of cervical collar use after a negative multidetector Computer Tomography scan result alone. Magnetic Resonance Imaging may detect a significant number of ligamentous injuries, but such injuries are rarely of clinical significance because they rarely alter clinical management. Its use should be limited to specific circumstances., Conclusion: It is important for institutions to re-examine the latest evidence regarding cervical spinal clearance in order to update their guidelines., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Helmet use during motorcycle crashes (MCCs) has been shown to reduce traumatic brain injury and mortality. However, preventive effects of its use on cervical spine injury remain controversial. In this study, we evaluated whether helmet use can reduce cervical spine injury during MCCs., Patients and Methods: A case-control study using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) registry was conducted. Cases were defined as patients with cervical spine injury [≥2 points in the Abbreviated Injury Scale (AIS)] in MCCs from 2011 to 2016. Four controls were matched to one case with strata which included age and sex from the EDIIS registry. Primary outcome was cervical spine injury, secondary outcome was intensive care unit (ICU) admission, and tertiary outcomes was mortality. Multivariable logistic regression analysis was used to calculate odds ratios (OR) with 95% confidence intervals (CIs) to evaluate the associations between helmet use and related outcomes., Results: In total, 2600 patients were analysed; among these, 1145 (44.0%) used helmets at the time of crashes. The helmet group showed lower alcohol consumption and mortality rates than the no helmet group (alcohol: 3.2% vs. 9.2%, respectively, and mortality: 2.4% vs. 7.1%, respectively; p <  0.01). Compared with the no helmet group, the helmet group was less likely to have cervical spine injury [adjusted OR, 0.62 (0.51-0.77)]. In addition, helmet use has been shown to help prevent ICU admission and mortality [adjusted OR, 0.45 (0.36-0.56) and 0.32 (0.21-0.51), respectively]., Conclusion: Helmet use was found to have significant preventive effects on cervical spine injury during MCCs., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To compare self-extraction with and without a cervical collar in subjects at low risk of cervical spine injuries., Material and Methods: Simulation study analyzing biomechanical data from inertial sensors to detect misalignment of the cervical spine during self-extraction with and without a cervical collar., Results: Misalignment was a mean (SD) 3.12 (34.62) degrees greater during self-extraction with a Stiffneck collar in place (95% CI, -15.33 to 21.57 degrees; P=.7234) than during extraction without a collar. Misalignment was also greater, by 5.95 (31.76) degrees, with an X-collar in place (95% CI, -10.98 to 22.87; P=.4654) than without a collar. The between-collar comparison of differences showed that misalignment was 2.83 (12.10) degrees greater with the X-collar (95% CI, -3.62 to 9.27 degrees; P=.3650)., Conclusion: Misalignment of the cervical spinal column is similar during self-extraction with or without a cervical collar in place.

Aims: Back strain is a common musculoskeletal complaint affecting musicians, which may be related to unsuitable playing positions causing fatigue and muscle tension. In this study, three saxophone-carrying systems (neck-strap, shoulder-strap, and Saxholder) were examined for their effects on spinal column kinematics., Methods: The influence of saxophone-carrying systems was investigated in 14 physically healthy alto saxophonists using ultrasound topometry. Additional tests were performed on 1 subject to examine the influence of the different weights of alto, tenor, and baritone saxophones with the three different carrying systems., Results: The clearest difference between two systems (shoulder-strap vs Saxholder) was found in the angle at which the player's head bows forward while playing (3.35°; 95% CI 0.44, 6.26; p=0.0272). The use of the Saxholder resulted in a physiologically favorable axial position of the head. The head posture to ankle distance showed that the shoulder-strap and Saxholder, compared to the neck-strap, allowed a sagittal straightening and therefore advantageous axially balanced body position, although the differences were not statistically significant. The Saxholder also enabled a stabilization in the frontal section of the shoulders. In additional tests on 1 subject, the coefficient of variation showed that the instruments' weights had a larger influence on the physiologically favorable balanced body position than the different carrying systems., Conclusion: This pilot study was able to show that the technique of sonometric examination (Zebris) is an effective way to investigate the influence of instrument-carrying systems on the kinematics of the spine. The Saxholder may be physiologically advantageous, but further research with a larger sample is needed to verify the findings.

Given the appropriate cues, kinematic factors associated with low back injury risk and pain, such as spine flexion, can be avoided. Recent research has demonstrated the potential for tactile sensory information to change movement. In this study an athletic strapping tape was applied bilaterally along the lumbar extensor muscles to provide continuous tactile feedback information during a repeated lifting and lowering task. The presence of the tape resulted in a statistically significant reduction in lumbar spine flexion when compared to a baseline condition in which no tape was present. This reduction was further increased with the explicit instruction to pay attention to the sensations elicited by the tape. In both cases, the reduction in lumbar spine flexion was compensated for by increases in hip and knee flexion. When the tape was then removed and participants were instructed to continue lifting as if it was still present, the reduction in lumbar flexion and increases in hip and knee flexion were retained. Thus this study provides evidence that tactile cues can provide vital feedback information that can cue human lumbar spine movement to reduce kinematic factors associated with injury risk and pain., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Activation of neuronal nicotinic acetylcholine receptors (nAChRs) by nicotine is reported to protect brain neurons from glutamate excitotoxicity. We inquired whether a similar phenomenon can occur in the rat isolated spinal cord (or spinal slice culture) challenged by a transient (1 hr) application of kainate (a powerful glutamate receptor agonist) to induce excitotoxicity mimicking spinal injury in vitro. We recorded spinal reflexes and fictive locomotion generated by the locomotor central pattern generator before and 24 hr after applying kainate. We also monitored network activity with Ca 2+ imaging and counted neurons and glia with immunohistochemical methods. In control conditions, nicotine (1 μM; 4 hr) depressed reflexes and fictive locomotion with slow recovery and no apparent neurotoxicity at 24 hr although synchronous Ca 2+ transients appeared in slice cultures. Kainate nearly halved neuron numbers (while sparing glia), decreased reflexes and Ca 2+ transients, and suppressed fictive locomotion. When nicotine was applied (4 hr) after washout of kainate, fictive locomotor cycles appeared 24 hr later though with low periodicity, and significant protection of neurons, including motoneurons, was observed. Nicotine applied together with kainate and maintained for further 4 hr yielded better neuroprotection, improved fictive locomotion expression and reversed the depression of Ca 2+ transients. nAChR antagonists did not intensify kainate neurotoxicity and inhibited the neuroprotective effects of nicotine. These data suggest that nicotine was efficacious to limit histological and functional excitotoxic damage probably because it activated and then desensitized nAChRs on excitatory and inhibitory network neurons to prevent triggering intracellular cell death pathways., (© 2018 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Background and Aims: Catastrophic cervical spine injuries are rare in rugby union but require close monitoring. The aim of this study was to analyse the incidence of severe cervical spine injuries and determine the impact of a national prevention programme and new scrum rules implemented by the French Rugby Union., Methods: A prospective study was performed between 2006 and 2013 including all players affiliated to the French Rugby Union. All cervical spine injuries resulting in death, tetraplegia or a permanent neurological deficit were included. Prevention programmes were implemented from 2007 to 2013 and a change in scrum rules in 2010. To measure the impact of rule changes, results between 2006-2010 and 2010-2013 were compared using a Poisson regression., Results: Altogether, 31 injuries were observed and the mean annual incidence was 1.6 per 100 000 players. There were significantly more injuries in senior players compared to junior players (3.5 vs 0.6 per 100 000 players; CI 95% (2.1 to 4.9) vs (0.1 to 1.0)). Incidence decreased from 1.8 in 2006 to 1.0 per 100 000 players in 2013 (p<0.0001). After 2010, there were significantly fewer injuries during scrums (p=0.02). In contrast, there were significantly more injuries in backs during 2010-2013 compared to 2006-2010 (p=0.003)., Conclusions: The incidence of catastrophic cervical spine injuries has declined in French Rugby Union. The implementation of specific prevention programmes and scrum law changes has notably resulted in a decrease in scrum injuries in forwards. This prospective study should be continued to monitor the future progression of injuries and adapt prevention programmes accordingly., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Competing Interests: Competing interests: None declared.

Skiing and snowboarding have increased in popularity since the 1960s. Both sports are responsible for a substantial number of musculoskeletal injuries treated annually by orthopaedic surgeons. Specific injury patterns and mechanisms associated with skiing and snowboarding have been identified. No anatomic location is exempt from injury, including the head, spine, pelvis, and upper and lower extremities. In these sports, characteristic injury mechanisms often are related to the position of the limbs during injury, the athlete's expertise level, and equipment design. Controversy exists about the effectiveness of knee bracing and wrist guards in reducing the incidence of these injuries. Understanding these injury patterns, proper training, and the use of injury prevention measures, such as protective equipment, may reduce the overall incidence of these potentially debilitating injuries.

Participation in any sport activity carries risk of cervical spine trauma, but certain activities have a higher risk than others, and hence, demand concerted efforts in developing prevention strategies. Prevention often includes efforts surrounding education of stakeholders, creating or modifying rules, and specific policies adopted for decreasing such risk. Stakeholders include sport clinicians, participants, coaches, parents, league administrators, officials, and the public. Thus, both athlete-specific and setting-specific factors must be considered and controlled to the extent possible for a multipronged approach for decreasing cervical spine injury risk. The effectiveness of certain strategies put into place in collision sports, such as American football, rugby, and ice hockey, is reviewed to illustrate this approach. Some research evidence exists that either has informed a strategy, or validated its effectiveness after the fact. More research of a higher level needs to be conducted in all sports to continue to contain the risk of cervical spine trauma to the fullest extent possible., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Describe prehospital Emergency Medical Services (EMS) providers' beliefs regarding spinal precautions for pediatric trauma transport., Methods: We randomly surveyed nationally certified EMS providers. We assessed providers' beliefs about specific precautions, and preferred precautions given a child's age (0-4 or 5-18 years) and presence of specific cervical spine injury (CSI) risk factors., Results: We received 5,400 responses (17%). Most were Paramedics (36%) or EMTs (22%) and worked at fire-based services (42%). A total of 47% endorsed responding to pediatric calls more than once per month. Consensus beliefs (>66% agreement) were that rigid cervical collars (68%) and long backboards with soft conforming surfaces (79%) maintain an injured pediatric spine in optimal position. Only 39% believed in the utility of the rigid long backboard to protect the pediatric spine. For most risk factors in both age categories, a rigid cervical collar with a long backboard with a soft conforming surface was the most common response (28-40% depending on age group and risk factor); however, there were no consensus beliefs. Provider-level experience, working as a patient care provider, less education, and parent status were associated with endorsing the rigid cervical collar. Factors associated with endorsing the rigid long backboard included provider level, working as a patient care provider, low pediatric call volume, and less education., Conclusions: EMS providers believe that rigid cervical collars and long backboards with soft conforming surfaces provide optimal spinal precautions. There were no consensus beliefs, however, for use of particular precautions based on age and risk factors.

Objectives: To analyze and compare measurements of spine kinematics during prehospital emergency responders' placement of a patient on a spinal backboard or a scoop stretcher., Material and Methods: Cross sectional, quasi-experimental clinical simulation to compare misalignment (main endpoint) by means of data from a 3-dimensional motion capture system., Results: Mean (SD) misalignment during placement on the 2 devices was 37.53° (14.15°). By device, mean misalignment was 31.08° (6.38°) for the scoop stretcher and 43.97° (7.97°) for the backboard (P=.048)., Conclusion: Less misalignment occurs during placement on the scoop stretcher than on the spinal backboard.

Background: Motorcyclists are a vulnerable road-user population who are overrepresented in traffic injuries. Utilisation of back protectors may be an effective preventive measure for spine injuries in motorcyclists. Since use of back protectors is increasing it is important that clinical evidence supports their use. The study aimed to investigate the current evidence on the ability of back protectors to reduce the rate of back injuries and patient mortality in motorcycle crashes., Methods: A systematic literature search was conducted using various electronic databases. Systematic reviews, randomised controlled trials, controlled clinical trials, cohort studies, case series and case reports were included Opinion pieces and laboratory or biomechanical studies were excluded. Back protectors and spine protectors were included as the intervention; neck braces and speed humps were excluded. The target outcomes were any injuries to the back or death. Only English language studies were included., Results: The search strategy yielded 185 studies. After excluding 183 papers by title and abstract and full-text evaluation, only two small cross-sectional studies were included. Foam inserts in motorcycle jackets and non-standard clothing may possibly be associated with higher risk of injuries, while hard shell and standard back protectors may possibly be associated with a reduced rate of back and spinal injury., Conclusion: This systematic review highlighted lack of appropriate evidence on efficacy of back protectors. Based on limited information, we are uncertain about the effects of back protectors on spinal injuries. Further research is required to substantiate the effects of back protectors on mortality and other injuries to the back.

Synopsis Head and spinal injuries commonly occur during motor vehicle crashes (MVCs). The goal of this clinical commentary is to discuss real-life versus simulated MVCs and to present clinical, biomechanical, and epidemiological evidence of MVC-related injury mechanisms. It will also address how this knowledge may guide and inform the design of injury mitigation devices and assist in clinical decision making. Evidence indicates that there exists no universal injury tolerance applicable to the entire population of the occupants of MVCs. Injuries sustained by occupants depend on a number of factors, including occupant characteristics (age, height, weight, sex, bone mineral density, and pre-existing medical and musculoskeletal conditions), pre-MVC factors (awareness of the impending crash, occupant position, usage of and position of the seatbelt and head restraint, and vehicle specifications), and MVC-related factors (crash orientation, vehicle dynamics, type of active or passive safety systems, and occupant kinematic response). Injuries resulting from an MVC occur due to blunt impact and/or inertial loading. An S-shaped curvature of the cervical spine and associated injurious strains have been documented during rear-, frontal-, and side-impact MVCs. Data on the injury mechanism and the quantification of spinal instability guide and inform the emergent and subsequent conservative or surgical care. Such care may require determining optimal patient positioning during transport, which injuries may be treated conservatively, whether reduction should be performed, optimal patient positioning intraoperatively, and whether bracing should be worn prior to and/or following surgery. The continued improvement of traditional injury mitigation systems, such as seats, seatbelts, airbags, and head restraints, together with research of newer collision-avoidance technologies, will lead to safer motor vehicles and ultimately more effective injury management strategies. J Orthop Sports Phys Ther 2016;46(10):826-833. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6716.

Context: The pocketing effect of helmet padding helps to dissipate forces experienced by the head, but if the player's helmet remains stationary in an opponent's shoulder pads, the compressive force on the cervical spine may increase., Objective: To (1) measure the coefficient of static friction between different football helmet finishes and football jersey fabrics and (2) calculate the potential amount of force on a player's helmet due to the amount of friction present., Design: Cross-sectional study., Setting: Laboratory., Patients or Other Participants: Helmets with different finishes and different football jersey fabrics., Main Outcome Measure(s): The coefficient of friction was determined for 2 helmet samples (glossy and matte), 3 football jerseys (collegiate, high school, and youth), and 3 types of jersey numbers (silkscreened, sublimated, and stitched on) using the TAPPI T 815 standard method. These measurements determined which helmet-to-helmet, helmet-to-jersey number, and helmet-to-jersey material combination resulted in the least amount of static friction., Results: The glossy helmet versus glossy helmet combination produced a greater amount of static friction than the other 2 helmet combinations (P = .013). The glossy helmet versus collegiate jersey combination produced a greater amount of static friction than the other helmet-to-jersey material combinations (P < .01). The glossy helmet versus silkscreened numbers combination produced a greater amount of static friction than the other helmet-to-jersey number combinations (P < .01)., Conclusions: The force of static friction experienced during collisions can be clinically relevant. Conditions with higher coefficients of static friction result in greater forces. In this study, the highest coefficient of friction (glossy helmet versus silkscreened number) could increase the forces on the player's helmet by 3553.88 N when compared with other helmet-to-jersey combinations. Our results indicate that the makeup of helmet and uniform materials may affect sport safety.

Context: Identification of strategies to prevent spinal injury, optimize rehabilitation, and enhance performance is a priority for practitioners. Different exercises produce different effects on neuromuscular performance. Clarity of the purpose of a prescribed exercise is central to a successful outcome. Spinal exercises need to be classified according to the objective of the exercise and planned physical outcome., Objective: To define the modifiable spinal abilities that underpin optimal function during skilled athletic performance, clarify the effect of spinal pain and pathologic conditions, and classify spinal exercises according to the objective of the exercise and intended physical outcomes to inform training and rehabilitation., Design: Qualitative study., Data Collection and Analysis: We conducted a qualitative consensus method of 4 iterative phases. An exploratory panel carried out an extended review of the English-language literature using CINAHL, EMBASE, MEDLINE, and PubMed to identify key themes and subthemes to inform the definitions of exercise categories, physical abilities, and physical outcomes. An expert project group reviewed panel findings. A draft classification was discussed with physiotherapists (n = 49) and international experts. Lead physiotherapy and strength and conditioning teams (n = 17) reviewed a revised classification. Consensus was defined as unanimous agreement., Results: After the literature review and subsequent analysis, we defined spinal abilities in 4 categories: mobility, motor control, work capacity, and strength. Exercises were subclassified by functionality as nonfunctional or functional and by spinal displacement as either static (neutral spinal posture with no segmental displacement) or dynamic (dynamic segmental movement). The proposed terminology and classification support commonality of language for practitioners., Conclusions: The spinal-exercise classification will support clinical reasoning through a framework of spinal-exercise objectives that clearly define the nature of the exercise prescription required to deliver intended physical outcomes.

Background: Most emergency transport protocols in the United States currently call for the use of a spine board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth., Methods: To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3kPa, and 3) maximal pressure (Pmax)., Results: In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. Pmax was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8kPa, p<0.001)., Conclusion: This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Rear seat occupants are now at a higher risk of injury relative to front seat occupants and there is a need for enhanced protection. This study aimed to examine the pattern of injury, injury mechanisms and injury sources to restrained motor vehicle rear seat occupants involved in a frontal impact., Methods: Cases involving restrained rear seat occupants aged 9 years and older involved in frontal crashes were prospectively collected from in-depth crash investigations collected in New South Wales and Victoria, Australia, between 2000 and 2010. Structured occupant and driver interviews were conducted to ascertain crash parameters, medical records were reviewed and detailed injury descriptions were recorded using the abbreviated injury scale (AIS). Vehicle and scene inspections were also conducted and injury sources determined., Results: The dataset included 29 rear seat occupants aged 9-80 years. AIS2+ injuries were most commonly observed in the chest and abdomen. Chest injuries were more commonly observed in older occupants, while abdominal and thoracolumbar spine injuries were mostly observed in younger occupants. The seat belt was the most common source of injury to rear seat occupants., Conclusions: The seat belt is the most common source of injury to rear seat passengers in frontal impact with variations in injury with age. There is a need to provide appropriate belt fit and better control seat belt loads for rear seat passengers. This could be achieved, at least in part, with existing technologies currently used in front seat positions, although novel technologies may also be useful., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Introduction: Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria., Methods: A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes., Results: There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12., Conclusion: Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Occupational diseases data can guide efforts to improve worker's health and safety., Aims: To describe MALPROF, the Italian system for surveillance of work-related diseases collected by the subregional Department of Prevention., Methods: The MALPROF system started in 1999 with contributions from Lombardy and Tuscany and spread in the following years to collect contributions from 14 out of the 20 Italian regions. MALPROF data were explored to follow-up work-related diseases and to detect emerging occupational health risks by calculating proportional reporting ratio (PRR), as in pharmacosurveillance. It classified work-related diseases according to economic sector and job activity in which the exposure occurred. Occupational physicians of the Italian National Health Service evaluate the possible causal relationship with occupational exposures and store the data in a centralized database., Results: From 1999 to 2012, the MALPROF system collected about 112000 cases of workers' diseases. In 2010, more than 13000 cases of occupational diseases were reported. The most frequently reported diseases were hearing loss (n = 4378, 32%), spine disorders (n = 2394, 17%) and carpal tunnel syndrome (n = 1560, 11%). The PRR calculated for cervical disc herniation, a disease whose occupational origin has to be studied, in 1999-2010 was 2.47 [95% confidence interval (CI) 1.76-3.47] for drivers and 36.64 (95% CI 22.03-60.93) for air transport workers., Conclusions: MALPROF is a sensitive system for identifying possible associations between occupational risks and diseases, it can contribute to the development of preventive measures, to evaluate the effectiveness of preventive interventions and to stimulate research on new occupational risks and diseases., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: This study aims to compare the efficacy of teriparatide, denosumab, and oral bisphosphonates for reducing fracture risk in postmenopausal women with osteoporosis., Methods: We searched the literature, via PubMed, Medline, Embase, and the Cochrane Library, to screen citations from January 1996 to October 2014 for inclusion in this study. A mixed-treatment comparison meta-analysis within a Bayesian framework was performed by WinBUGS version 1.4.3 software. The proportions of women with vertebral fractures and women with nonvertebral fractures were analyzed., Results: Our meta-analysis results indicated that all of the therapies-except etidronate-achieved a statistically significant reduction of fractures compared with placebo. Teriparatide and denosumab were more effective than alendronate and risedronate for reducing vertebral fracture (teriparatide vs alendronate: odds ratio [OR], 1.76; 95% CI, 1.03-2.98; teriparatide vs risedronate: OR, 1.92; 95% CI, 1.13-3.19; denosumab vs alendronate: OR, 1.67; 95% CI, 1.06-2.67; denosumab vs risedronate: OR, 1.84; 95% CI, 1.16-2.92). Teriparatide, denosumab, alendronate, and risedronate also reduced the risk of nonvertebral fracture compared with placebo. Results of subgroup analysis showed that denosumab (OR, 0.6; 95% CI, 0.37-0.98), alendronate (OR, 0.61; 95% CI, 0.39-0.96), and risedronate (OR, 0.63; 95% CI, 0.46-0.86) can reduce the risk of hip fracture and that risedronate (OR, 0.59; 95% CI, 0.4-0.88) can also reduce the risk of upper-arm fracture., Conclusions: Teriparatide, denosumab, alendronate, and risedronate are effective in reducing the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Furthermore, denosumab, alendronate, and risedronate can reduce the risk of hip fracture, and risedronate can also reduce the risk of upper-arm fracture.

Study Design: In vitro animal cadaveric study., Objective: To identify the appropriate rotational speed and safe bone distance from neural tissue during bone burring in spinal surgery., Summary of Background Data: Bone burring is a common step in spinal surgery. Unwanted frictional heat produced during bone burring may result in thermal injury to the bone and adjacent neural structure. One of the important parameters influencing the bone temperature rise during bone burring is rotational speed., Methods: This laboratory-based animal study used bovine spine bones, and the tests were conducted using a steel round burr. The bone temperature was measured simultaneously with thermocouple at the distances of 1 mm, 3 mm, and 5 mm from the burring site during the burring process. The bone burring was done with 4 different rotational speeds of 35,000 revolutions per minute (rpm), 45,000 rpm, 65,000 rpm, and 75,000 rpm., Results: This study showed that increasing the rotational speed significantly elevated bone temperature. The threshold temperature of 47°C was reached when bone was burred for 10 seconds, with a rotational speed of 45,000 rpm. The mean bone temperature measured at a distance 1 mm from the burring site for all 4 rotational speeds was always higher than that measured at a distance of 3 mm and 5 mm and this difference was statistically significant (P < 0.001). There was no significant difference between the mean bone temperature measured at a distance of 3 mm and 5 mm (P > 0.05)., Conclusion: Taking 47°C as the threshold temperature for causing significant impairment to the regenerative capacity of bone, a rotational speed of lower than 45,000 rpm is preferable so as to minimize thermal injury to bone tissue. We also concluded that a 3-mm distance between the site of burring and the neural tissue is a safe distance., Level of Evidence: N/A.

Introduction: The goal of this study was to compare application of the Kendrick Extrication Device (KED) versus rapid extrication (RE) by emergency medical service personnel. Our primary endpoints were movement of head, time to extrication and patient comfort by a visual analogue scale., Methods: We used 23 subjects in two scenarios for this study. The emergency medical services (EMS) providers were composed of one basic emergency medical technician (EMT), one advanced EMT. Each subject underwent two scenarios, one using RE and the other using extrication involving a commercial KED., Results: Time was significantly shorter using rapid extraction for all patients. Angles of head turning were all significantly larger when using RE. Weight marginally modified the effect of KED versus RE on the "angle to right after patient moved to backboard (p= 0.029) and on subjective movement on patient questionnaire (p=0.011). No statistical differences were noted on patient discomfort or pain., Conclusion: This is a small experiment that showed decreased patient neck movement using a KED versus RE but resulted in increased patient movement in obese patients. Further studies are needed to determine if the KED improves any meaningful patient outcomes in the era of increased evidence-based medicine in emergency medical services.

Background: Posterior fusion procedures (posterior lumbar interbody fusion, PLIF; transforaminal lumbar interbody fusion, TLIF) are long-established surgical techniques for lumbar interbody fusion. They differ from anterior lumbar interbody fusion (ALIF) and extreme lateral interbody fusion (XLIF) procedures by approach and associated complications., Objectives: The posterior fusion procedures PLIF and TLIF are presented and compared with other fusion methods, including advantages and disadvantages. Furthermore, the surgical technique and their complications are described. Based on the current literature, it is discussed which surgical techniques can be used in various cases., Materials and Methods: A PubMed search of "posterior spinal fusion treatments" and the clinical experience of the authors are summarized in this review article., Results: PLIF and TLIF procedures reduced back and leg pain, restored the sagittal profile of the lumbar spine, and achieved good fusion rates and long-term stability. Advantages of the TLIF procedure include shorter operative times, less blood loss, less intraoperative risk of injury to neural structures, and shorter convalescence. Compared with the interposition of a cage in the ALIF technique, a further step with the risk of vascular injury is eliminated., Conclusions: The PLIF and TLIF procedures are almost equivalent posterior fusion procedures with high fusion rates, good long-term clinical outcomes, and low risk of complications. The TLIF procedure is slightly advantageous: lower nerve irritation rates, shorter operative times, and less extensive operation. Thus, the TLIF procedure is available for cases with single-sided pathologies and the PLIF procedure is available for bilateral compressions.

Head trauma is leading cause of mortality after injuries related with skiing and snowboarding. Wearing a helmet is considered to be a primary method to prevent traumatic brain injuries (TBI) among alpine sports participants. This article, based on literature review, determines the efficacy of helmets and safety of their use. It also presents practical principles of proper helmet fitting. A well proven reduction in the risk of TBI connected with helmet use is reported in the literature, ranging from 22 to 60%. Helmet use does not increase the risk of neck and C-spine injury. There is no good evidence to support the claim that use of helmets increases the risk compensation behaviors among participants. Proper fit includes adequate size, non-attenuated peripheral vision and hearing, well adjusted retention system (chinstrap). This factors may influence both efficacy and safety of helmet use. Helmets are recommended for all skiers and snowboarders.

The international scientific literature reports no data on the prevalence and effectiveness of back protector devices (BPD). In Italy, no data have been collected on BPD because their use is not mandatory. To fill this gap, the National Institute of Health implemented a cross-sectional study in collaboration with the National Traffic Police.Accident cases were collected from 1 December 2011 to 25 October 2013. Overall, data from 2104 accidents involving 2319 injured subjects were analysed: 1821 (78.5%) of these were motorcyclists and 498 (21.5%) mopedists. The use of Hard-shell BPD or jackets with airbags in motorcyclists is higher then in moped drivers (16.2% vs 1.3%,P¼0.000). Concerning level of protection, there are no differences between drivers and passengers. In most severely injured motorcyclists (i.e. hospitalized or deceased), the percentage of injuries to the spine was lower (13.6%) among those who used a high level safety device (hard-shell BPD and/or airbags) and rose to 27.3% among those who used only protective clothing (P¼0.022). When the variables potentially affecting the results of not using a high-safety device were controlled, a bivariate analysis showed that the odds of serious spinal injury were 2.72 times greater (P¼0.049) and a multivariate analysis showed that they were 2.81 times greater (P¼0.012). This study points out that greater use of BPD could reduce the number of injuries to the spinal column resulting from road traffic accidents involving motorized two-wheeled vehicles.

Introduction: Despite a number of injury prevention campaigns and interventions, horse riding continues to be a dangerous activity, resulting in more accidents per hour than motorcycling, skiing and football. Injuries are often serious, with one in four patients requiring admission to hospital. This study aims to describe the severity of equestrian-related injuries (ERIs) using both clinical parameters and patient-reported outcomes., Patients and Methods: A retrospective study of all patients aged ≥18 years admitted to The Alfred Hospital between January 2003 and January 2008 with an ERI was performed. Specific clinical data were extracted from the medical record. In addition, a questionnaire was conducted identifying the details of the accident, the required recovery time and levels of ongoing pain and physical disability., Results: During the study period 172 patients met the inclusion criteria. There were three deaths (2%). Eighty-two patients (48%) suffered head injuries. Forty-one patients (24%) were admitted to the ICU and 31 patients (18%) required mechanical ventilation. On discharge, 41 patients (24%) required transfer to a sub-acute rehabilitation facility. One-hundred-and-twenty-four patients (72%) completed the questionnaire. Thirty-nine respondents (31%) were not wearing a helmet. Among patients injured for more than 6 months, 38 (35%) still experienced moderate or severe pain or disability. Ninety-five patients had returned to work at the time of review, among which 47(50%) required longer than 6 months to recover, and 40 (42%) returned at a reduced capacity., Conclusions: The clinical and patient-reported outcomes of ERIs requiring hospital admission are poor. Persistent pain and disability are common, even up to 5 years post-injury. A large proportion of patients required longer than 6 months to return to work and many return at a reduced capacity., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Field spinal immobilization using a backboard and cervical collar has been standard practice for patients with suspected spine injury since the 1960s. The backboard has been a component of field spinal immobilization despite lack of efficacy evidence. While the backboard is a useful spinal protection tool during extrication, use of backboards is not without risk, as they have been shown to cause respiratory compromise, pain, and pressure sores. Backboards also alter a patient's physical exam, resulting in unnecessary radiographs. Because backboards present known risks, and their value in protecting the spinal cord of an injured patient remains unsubstantiated, they should only be used judiciously. The following provides a discussion of the elements of the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACS-COT) position statement on EMS spinal precautions and the use of the long backboard. This discussion includes items where there is supporting literature and items where additional science is needed.

Background: Here we describe the Systematically Tabulated Outcomes Research Matrix (STORM) method to generate research questions from pre-existing databases with the aim of improving patient outcomes., Materials and Methods: STORM can be applied to a database by tabulating its variables into a matrix of independent variables (y-axis) and dependent variables (x-axis) and then applying each unique pairing of an independent and dependent variable to a patient population to generate potentially meaningful research questions., Results: To demonstrate this methodology and establish proof-of-principle, STORM was applied on a small scale to the National Trauma Data Bank and generated at least seven clinically meaningful research questions., Conclusion: When coupled with rigorous clinical judgment, the STORM approach complements the traditional method of hypothesis formation and can be generalized to outcomes research using registry databases across different medical specialties., (Copyright © 2014 Mosby, Inc. All rights reserved.)

Context: The National Athletic Trainers' Association position statement on acute management of the cervical spine-injured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols., Objective: To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative pack-and-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels., Design: Crossover study., Setting: Movement analysis laboratory., Patients or Other Participants: Eight male collegiate football players (age = 21.4 ± 1.4 years; height = 1.87 ± 0.02 m; mass = 103.6 ± 12.5 kg)., Intervention(s): Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by pack-and-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal., Main Outcome Measure(s): We measured head movement relative to sternum movement (translations and rotations). We used 4 × 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs., Results: Protocol HP resulted in a 0.1 ± 0.6 cm rise in head position compared with a 1.4 ± 0.3 cm drop with protocol HS (P < .001). Protocol HP produced 4.9° less total angular excursion (P < .001) and 2.1 cm less total vertical excursion (P < .001) than protocol HS., Conclusions: The pack-and-fill protocol was more effective than shoulder pad removal in minimizing cervical spine movement throughout the equipment-removal process. This study provides evidence for including the pack-and-fill protocol in future treatment recommendations when helmet removal is necessary for on-field care.

Load carriage is a physically demanding task that is often required of employees in many different occupations. The Mover's Assistive Device (MAD) is an on-body ergonomic assistive device designed to help professional movers transfer boxes during two techniques of hand-held load carriage: anterior carriage and posterior carriage. The purpose of this study was to examine the intersegment coordination between the trunk and pelvis as well as the trunk and box, since coordination may be a mechanism to reduce the amount of stress exerted on the back during load carriage. Thirteen males completed a hand-held load carriage task in a laboratory setting using two popular techniques employed by professional movers (anterior/posterior), with and without the assistance of the Mover's Assistive Device (MAD); resulting in a total of four conditions. Triads of retro-reflective markers tracked the angular positions of the trunk, pelvis and the load being carried. Intersegment coordination between the trunk-pelvis and the box-trunk were measured using continuous relative phase angles in the transverse plane of motion. No trunk coordination differences were observed across carrying techniques (anterior/posterior); however, under all conditions users walked with a near in-phase coordination pattern, which is believed to help reduce the risk of injury. MAD use resulted in decreased perceived discomfort and more in-phase coordination between the trunk-pelvis, which may help reduce injury risk when carrying loads either anteriorly or posteriorly., (© 2013 Elsevier Ltd. All rights reserved.)